In-stent thrombosis and stenosis after neck-remodeling device-assisted coil embolization of intracranial aneurysms

Hilal Kanaan, Brian Jankowitz, Aitziber Aleu, Dean Kostov, Ridwan Lin, Kimberly Lee, Narendra Panipitiya, Yakov Gologorsky, Emir Sandhu, Lauren Rissman, Elizabeth Crago, Yue Fang Chang, Seong Rim Kim, Tudor Jovin, Michael Horowitz

Research output: Contribution to journalArticlepeer-review

53 Scopus citations


BACKGROUND: Intrinsic thrombosis and stenosis are complications associated with the use of neck-remodeling devices in the treatment of intracranial aneurysms. OBJECTIVE: To examine the technical and anatomic factors that predict short- and long-term stent patency. METHODS: We undertook a retrospective review of 161 patients who underwent coil embolization of 168 ruptured and unruptured aneurysms assisted by the use of a neck-remodeling device. One hundred twenty-seven patients had catheter-based angiographic follow-up to evaluate 133 stent-coil constructs (mean, 15.4 months; median, 12.7 months). The technique of microcatheter jailing was used in a majority of patients; nonstandard stent configurations were also used. RESULTS: Clinical follow-up for all patients who had catheter-based angiograms demonstrated that among 133 stent constructs, a total of 9 (6.8%) had an in-stent event: 6 acute or subacute thrombosis (4.5%) and 3 delayed stenosis or occlusion (2.3%). Seven of these constructs were associated with a symptomatic event (5.3%). A significantly higher rate of in-stent events was seen with the use of constructs to treat anterior communicating artery aneurysms. When all patients are considered, including those who did not receive catheter-based follow-up imaging, 2 of 168 procedures (1.2%) resulted in the death of a patient, and procedural morbidity was 14.9%. CONCLUSION: From these results and those in the published literature, in-stent complication rates are low in carefully selected patients. The use of dual antiplatelet therapy, sensitivity assays, and glycoprotein IIb/IIIa inhibitors may decrease the rate of acute and chronic in-stent complications.

Original languageEnglish
Pages (from-to)1523-1532
Number of pages10
Issue number6
StatePublished - Dec 2010


  • Aneurysm
  • Coil
  • In-stent stenosis
  • Neck-remodeling device
  • Stent
  • Stent-assisted coiling
  • Stent-coil


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